<!DOCTYPE html>
<html lang="en">
<head>
  <meta charset="UTF-8">
  <title>体检退费申请</title>
  <link rel="stylesheet" type="text/css" href="../../../../themes/default/easyui.css">
  <link rel="stylesheet" type="text/css" href="../../../../themes/icon.css">
  <script type="text/javascript" src="../../../../easyui/js/jquery.min.js"></script>
  <script type="text/javascript" src="../../../../easyui/js/jquery.easyui.min.js"></script>
  <style>
    body {
      font-size: 14px;
      padding: 0;
      margin: 0;
      background-color: #eee;
    }
    a {
      display: inline-block;
      text-decoration: none;
      color: #000;
      padding: 0;
      margin: 0;
    }
    .container {
      padding: 30px 50px;
      box-sizing: border-box;
    }
    .title {
      width: 100%;
      height: 50px;
      line-height: 50px;
      border-bottom: 3px solid #000;
    }
    .content{
      display: flex;
      background: white;
    }
    .left-content{
      width: 50%;
      margin: 10px;
    }
    .left-content .member-list {
      padding-top: 50px;
      background: yellow;
    }


    .form-content{
      width: 800px;
      margin-left: 20px;
      overflow: hidden;
    }
    .form-item{
      float: left;
      height: 30px;
      line-height: 30px;
      margin-right: 20px;
      margin-top: 20px;
      margin-bottom: 10px;
    }
    .form-item .btn {
      /* width: 80px; */
      padding: 0 10px;
      height: 30px;
      line-height: 30px;
      text-align: center;
      color: #fff;
      font-size: 16px;
      background: rgba(64, 158, 255, 1);
      border-radius: 5px;
    }
    .right-content{
      width: 50%;
      padding-left: 20px;
    }
    .refundDetail {
      display: flex;
      align-items: center;
    }
    .refundDetail .refund_title {
      background: yellow;
      height: 30px;
      line-height: 30px;
    }

  </style>
</head>
<body>
  <div class="container">
    <div class="title">退费申请</div>
    <div class="content">
      <div class="left-content">
        <h4 style="margin-bottom: 0;">体检记录</h4>
        <form class="form-content" id="project-name-form" method="post">
          <div class="form-item">
            <label for="projectName">读档:</label>
            <input class="easyui-validatebox" placeholder="请输入" type="text" id="projectName" name="projectName" style="width: 270px;height: 30px;"/>
          </div>
          <div class="form-item">
            <label for="projectName">体检号:</label>
            <input class="easyui-validatebox" disabled placeholder="请输入" type="text" id="projectName" name="projectName" style="width: 250px;height: 30px;"/>
          </div>
          <div class="form-item">
            <label for="projectName">发票号:</label>
            <input class="easyui-validatebox" placeholder="请输入" type="text" id="projectName" name="projectName" style="width: 250px;height: 30px;"/>
          </div>
          <div class="form-item">
            <label for="projectName">订单号:</label>
            <input class="easyui-validatebox" placeholder="请输入" type="text" id="projectName" name="projectName" style="width: 250px;height: 30px;"/>
          </div>
          <div class="form-item">
           <a href="#" class="btn">读卡</a>
           <a href="#" class="btn">查询</a>
          </div>
        </form>

        <div class="charges-content" style="margin-top: 50px;">
          <table class="easyui-datagrid" data-options="ctrlSelect:true,pagination:true" style="width:100%;">
            <thead>
              <tr>
                <th data-options="field:'a1',width:80,align:'center'">发票号</th>
                <th data-options="field:'a3',width:150,align:'center'">订单号</th>
                <th data-options="field:'a4',width:150,align:'center'">套餐/项目名称</th>
                <th data-options="field:'a5',width:50,align:'center'">姓名</th>
                <th data-options="field:'a6',width:50,align:'center'">性别</th>
                <th data-options="field:'a7',width:150,align:'center'">收费时间</th>
                <th data-options="field:'a8',width:100,align:'center'">开单科室</th>
                <th data-options="field:'a9',width:80,align:'center'">开单医生</th>
                <th data-options="field:'a10',width:80,align:'center'">受单科室</th>
              </tr>
            </thead>
            <tbody>
              <tr>
                <td>024546</td>
                <td>1564512345165155645</td>
                <td>甲功四项等5个项目</td>
                <td>李丽</td>
                <td>女</td>
                <td>2024-03-01 13:25:26</td>
                <td>体检中心</td>
                <td>李锐</td>
                <td>药房</td>
              </tr>
              <tr>
                <td>024546</td>
                <td>1564512345165155645</td>
                <td>甲功四项等5个项目</td>
                <td>李丽</td>
                <td>女</td>
                <td>2024-03-01 13:25:26</td>
                <td>体检中心</td>
                <td>李锐</td>
                <td>药房</td>
              </tr>
              <tr>
                <td>024546</td>
                <td>1564512345165155645</td>
                <td>甲功四项等5个项目</td>
                <td>李丽</td>
                <td>女</td>
                <td>2024-03-01 13:25:26</td>
                <td>体检中心</td>
                <td>李锐</td>
                <td>药房</td>
              </tr>
              <tr>
                <td>024546</td>
                <td>1564512345165155645</td>
                <td>甲功四项等5个项目</td>
                <td>李丽</td>
                <td>女</td>
                <td>2024-03-01 13:25:26</td>
                <td>体检中心</td>
                <td>李锐</td>
                <td>药房</td>
              </tr>

            </tbody>
          </table>
        </div>

      </div>
      <div class="right-content">
        <h4 style="margin-bottom: 0;">退费申请</h4>
        <div class="refundDetail">
          <div class="form-item" style="margin-right: 30px;">退费金额: <span style="color: red;font-size: 18px;font-weight: 700;">26.67</span></div>
          <div class="form-item" style="margin-right: 30px;">
            <label for="projectName">退费原因:</label>
            <select id="defaultGrouping" class="easyui-combobox" placeholder="请选择" name="dept" style="width:150px;height: 30px;">
              <option>请选择</option>
              <option>太贵</option>
              <option>项目重复</option>
              <option>协商一直退款</option>
            </select>
          </div>
          <div class="form-item">
            <a href="#" class="btn" style="background-color: #E6A23C;">申请退费</a>
            <a href="#" class="btn" style="background-color: #f56c6c;">撤销申请</a>
            <a href="#" class="btn">打印退费单</a>
          </div>
        </div>
        <div class="charges-content" style="margin-top: 50px;">
          <table class="easyui-datagrid" data-options="ctrlSelect:true,pagination:true" style="width:100%;">
            <thead>
              <tr>
                <th data-options="field:'a1',width:150,align:'center'">套餐/项目名称</th>
                <th data-options="field:'a3',width:50,align:'center'">数量</th>
                <th data-options="field:'a4',width:50,align:'center'">单位</th>
                <th data-options="field:'a5',width:80,align:'center'">执行状态</th>
                <th data-options="field:'a6',width:80,align:'center'">退款状态</th>
                <th data-options="field:'a7',width:80,align:'center'">可退数量</th>
                <th data-options="field:'a8',width:100,align:'center'">申请数量</th>
                <th data-options="field:'a9',width:80,align:'center'">实付金额</th>
                <th data-options="field:'a10',width:150,align:'center'">不可退款原因</th>
                <th data-options="field:'a11',width:80,align:'center'">退款原因</th>
              </tr>
            </thead>
            <tbody>
              <tr>
                <td>2024职工体检</td>
                <td>5</td>
                <td>次</td>
                <td>已执行</td>
                <td>申请退费</td>
                <td>10</td>
                <td>
                  <input type="text" style="width: 50px;">
                </td>
                <td>355.00</td>
                <td>已执行项目不可退费</td>
                <td>协商一致退款</td>
              </tr>
              <tr>
                <td>2024职工体检</td>
                <td>5</td>
                <td>次</td>
                <td>已执行</td>
                <td>申请退费</td>
                <td>10</td>
                <td>
                  <input type="text" style="width: 50px;">
                </td>
                <td>355.00</td>
                <td>已执行项目不可退费</td>
                <td>协商一致退款</td>
              </tr>
              <tr>
                <td>2024职工体检</td>
                <td>5</td>
                <td>次</td>
                <td>已执行</td>
                <td>申请退费</td>
                <td>10</td>
                <td>
                  <input type="text" style="width: 50px;">
                </td>
                <td>355.00</td>
                <td>已执行项目不可退费</td>
                <td>协商一致退款</td>
              </tr>
              <tr>
                <td>2024职工体检</td>
                <td>5</td>
                <td>次</td>
                <td>已执行</td>
                <td>申请退费</td>
                <td>10</td>
                <td>
                  <input type="text" style="width: 50px;">
                </td>
                <td>355.00</td>
                <td>已执行项目不可退费</td>
                <td>协商一致退款</td>
              </tr>


            </tbody>
          </table>
        </div>
      </div>
    </div>
  </div>
</body>
</html>
